Wednesday, August 18, 2010

Imperforate Anus

This is a congenital anomaly where the rectum ends in a blind pouch and you might have an opening into the vulvovaginal area in females and urethra in males. This is considered a disorder which have occurred during embryogenesis in the hindgut. This occurs in 1 in 5000 livebirths with slight male preponderance. This are classified into two kinds a low lying and a high lying rectal pouch. The experts use the pubococcegeal line as a guide to determine if the lesion is high or low. High lesions usually come with an underlying fistula wither rectourinary or rectovginal fistula.

This is present at birth and the first things that happens is that you would not notice stools in the first 24 hours and this could be associated with abdominal distention. In some cases where there is a fistula you can see the stools and the urine seem to come in the same opening. If you notice this the first thing to do is transfer the baby at a pediatric surgical center,do not feed the baby temporarily then administer IV fluids and IV antibiotics specially when there is a fistula through the urinary tract. We worry about t a urinary tract infection.
Diagnosis can be done with a combination of physical examination and and x-rays.
this is associated with the VACTERL syndrome (vertebral anomalies, anal atresia, cardiac problems, Tracheoesophageal fistula, renal problems and limb abnormalithes.

Need to watch for constipation as the child grows bigger and to take care of this problem medically. The surgeon is consulted for anoplasty and serial dilations will be done. colostomy is done for high lesions.

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